Specialty billing
Gastroenterology Medical Billing and Endoscopy Coding
Endoscopy and colonoscopy coding where the screening-versus-diagnostic distinction decides who pays.
The challenge
What makes gastroenterology billing different
Gastroenterology billing lives or dies on one distinction: whether a procedure was screening or diagnostic, and what happened during it that may have changed the answer. A screening colonoscopy that becomes therapeutic when a polyp is removed is still preventive in intent, and coding it as though it were not can hand the patient a bill they should never have received.
Add a high procedure volume, a professional and facility split for practices with an endoscopy suite, plus separate anesthesia and pathology claims arising from the same encounter, and small coding habits compound quickly into large variances.
Why us
Why practices move their GI billing to us
Specialty billing is not a marketing label for us. Coders and A/R staff are assigned by specialty, so the person on your account reads notes like yours every day.
Get a free assessment- Coders who work endoscopy documentation daily, not occasionally
- Screening and diagnostic conversion rules applied consistently across every payer
- Facility and professional components reconciled against each other, not billed in isolation
- Pathology and anesthesia claims tracked back to the parent procedure
Scope of work
What we handle for gastroenterology practices
The work below is specific to this specialty, not a generic billing checklist with the name swapped out.
Endoscopy and colonoscopy coding
Diagnostic, screening and therapeutic procedures coded to the technique and findings actually documented.
Screening to diagnostic conversion
Correct use of the modifiers that preserve preventive benefit status when a screening becomes therapeutic.
Professional and facility split
Both components reconciled where the practice operates its own ambulatory endoscopy suite.
Anesthesia claim coordination
Monitored anesthesia claims aligned with the procedure record so the two do not contradict each other.
Pathology follow-through
Specimen claims tracked from collection to result so biopsy work does not go unbilled.
Surveillance interval tracking
Repeat procedure timing checked against payer frequency rules before the claim is submitted.
The Right Way difference
The details we watch on every GI claim
These are the details that separate a paid claim from an appealed one in gastroenterology. They are checked on every claim, not sampled.
- 01 Whether the indication documented supports screening status or a diagnostic indication from the outset
- 02 Modifier application when a screening procedure converts, so patient cost sharing stays correct
- 03 Payer-specific frequency limits on surveillance colonoscopy, which vary more than most practices expect
- 04 Multiple endoscopy payment rules, where the base value of the second procedure is reduced
- 05 Documentation of technique, extent reached and findings, which is what an audit will actually read
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Years running revenue cycles for physician practices
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Providers billed for across every specialty we serve
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First-pass clean claim rate
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Median days in accounts receivable
Questions
Gastroenterology billing questions
What practices in this specialty ask us most often before making a change.
Ask us something elseAlmost always because the claim did not preserve preventive status after a polyp was removed. The intent of the procedure governs the benefit, and the coding has to reflect that intent. Getting this right is one of the first things we fix.
Yes. We handle the professional and facility components together and reconcile them against each other, which is how missing facility claims get caught.
In most cases yes. We read from your endoscopy report and your EHR, whether those are one system or two, and we will confirm compatibility during the assessment before any commitment.
How it works
Getting started takes about a month
The same four steps whichever specialty you are in. No system migration and no gap in your cash flow.
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01
Revenue assessment
We audit a sample of your claims, denials and aged A/R and show you what we found. Free, and yours to keep either way.
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02
Scope and agreement
A written scope covering exactly which services we run, what it costs and what we are accountable for.
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03
Access and onboarding
We set up inside your existing EHR and clearinghouse. Two to four weeks, run in parallel with your current process.
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04
Live and reporting
We take over submission and follow-up, and you get monthly reporting you can actually act on.
Free consultation
Let us look at your gastroenterology claims
Send us a sample and we will tell you specifically what is being coded, denied or under-paid — and what it is worth to fix. Free, and yours to keep.